An overview of the various granulomas
Granuloma is a lesion which is chronic, focal, and consist of macrophage cells formed in response to an inflammation. It might also comprise of other cells like giant cells, eosinophils, mast cells etc. it is formed in response to a foreign agent that causes damage to the tissues. This is usually an inflammatory response mediated by T-lymphocytes.
Generalized granuloma annulare is a chronic granulomatous skin disease for which good treatment does not exist. Its cause is not clear, although injury to the skin could be related to onset in a few cases. Its pathogenesis is probably immunologic, and a delayed hypersensitivity mechanism seems the best interpretation of the known studies and pathology. Additional means to suppress T cell reactions may prove useful in the future. Center of plaques is composed of coalescing papules.
Malignancy was diagnosed with annular more than with nonannular lesions. Certain types of hyperlipidemia were significantly more frequent in those patients with annular lesions.
Generalized granuloma annulare, nonannular variant- Coalescing papules form erythematous plaques that cover large areas of extremities. most commonly affected region of the skin. Sun exposure as a precipitating factor for generalized granuloma annulare was implicated by history alone in two of our patients, by history and striking accentuation in sun-exposed areas in two other patients, and by characteristic distribution without supporting history in three patients. Precipitation of generalized granuloma annulare by sunburn, 12 psoralens plus ultraviolet A (PUVA) therapy, and insect bites has been reported by studies A 22% prevalence of some form of drug allergy, as well as development of lesions as a consequence of hypersensitivity reactions to orally and intravenously administered medications. Therapy for generalized granuloma annulare has been largely disappointing despite sporadic reports of limited success with agents such as systemic corticosteroids, chloroquine, potassium iodide, sulfones, niacinamide, and chlorpropamide.
Other types of granulomas
When the inflammation in the tissues become calcified in due course of time, then it is called calcified granuloma. Calcium will get deposited in the lesion slowly. Most of often caseous granuloma occur in brains.
The granuloma becomes necrosed with dead cells and resembles a cheese like appearance.
Non- caseating granulomas
This granuloma is not necrotic and not infectious in origin. It can occur in lungs, chest, liver etc.
This type of granuloma occurs on the belly of a baby. It can be seen when the umbilical cord is dry or has fallen.
The pyogenic granuloma is a benign growth of the skin or mucous membrane. Clinically it may appear alarming as a rapidly growing soft, pedunculated tissue mass with a fiery red colour and a glossy lobular surface, frequently with ulceration. It is mostly non-tender and bleeds easily. It is more common in women than in men with well-defined changing sex-ratios with age. and is most common between 20-40 years of age. In the oral cavity the gingiva is the most common site of occurrence with a preponderance of the granuloma anteriorly on the labial part of the gingiva in the maxilla.
Only a small number of studies has dealt with its aetiology and pathogenesis and early descriptions the pyogenic granuloma, as the name implies, was regarded as a response to pyogenic organisms. However, the conclusions from more recent studies of pyogenic granulomata hint at some initial traumatic condition as the main aetiological factor. It has been shown that pyogenic granulomata located at extragingival sites in the oral cavity often have positive information on preceding injuries. Furthermore, there is evidence of an association with specific injuries, as pyogenic granulomata have been recorded among upholstery workers who had pricked their fingers with sewing needles, among females who had bored their noses for ornamental purposes and among patients who had received smallpox vaccination.
Of pyogenic granulomata affecting the skin there is an increased incidence of the growth on hands and fingers in Western populations whereas in rural African populations the incidence on feet and toes is comparable to that of the hands. Although there is only little positive information on preceding injuries at these sites, it might be assumed that the majority of small injuries here scarcely are noticed. Despite lack of evidence, the main aetiological factor of lesions at gingival sites is thought also to be traumatic. As a majority of gingival granulomata are located on the labial gingiva in the anterior region of the oral vestibule, it seems tempting to postulate that habitual toothbrushing which mainly is confined to vestibular tooth surfaces may be considered as a significant cause of microtrauma and irritation to the gingiva.
Another local irritant which may be significant in the pathogenesis of the granuloma is gingival inflammation. Such inflammation is a direct response to the presence of bacterial plaque. It may become more severe by elevated levels of progesterone: a condition present in pregnancy and by intake of oral contraceptives.